From patterns to pathways: Latent class trajectories of self-perceptions of aging and their causal effects on multi-state functional transitions

Objectives

This study examines the heterogeneous developmental trajectories of self-perceptions of aging (SPA) and their causal effects on functional health transitions in older adults. Specifically, we aim to identify latent classes of SPA development, assess their impact on multi-state functional transitions, and quantify the loss in healthy life expectancy attributable to negative SPA.

Methods

Drawing from the Chinese Longitudinal Healthy Longevity Survey (2008–2018; n = 14,020), we implemented latent class trajectory modeling to identify SPA developmental patterns. We then applied multi-state Markov models to examine the effects of SPA on transitions among functional states (fully independent, assistance needed, and deceased), and established a counterfactual framework to estimate the loss in multi-state life expectancy attributable to SPA.

Results

Analysis revealed two distinct SPA trajectories: a high-level group (57.75 %) and a low-level group (42.25 %), both exhibiting declining trends while maintaining consistent level differences. After adjusting for demographic characteristics, negative SPA significantly increased the risk of functional impairment (HR=1.31, 95 % CI: 1.20–1.44) and diminished the probability of functional recovery (HR=0.61, 95 % CI: 0.53–0.71). At age 65, negative SPA was associated with a 2.18-year reduction in total life expectancy, with substantial disparities in healthy life expectancy (10.93 vs. 7.96 years).

Discussion

This study reveals two distinct trajectories of SPA in later life and demonstrates its causal effects on health state transitions. Early interventions targeting negative aging perceptions, particularly before age 65, may effectively extend healthy life expectancy.